No abstract

In this study, the prevalence of a broad range of Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) Axis I disorders (Composite International Disorder Interview) and all Axis II disorders (International Personality Disorder Examination) is determined with standardized, semistructured interviews of a group of 39 male forensic inpatients. Substance abuse (75.7%) and mood (51.3%) and anxiety (40.3%) disorders were the most prevalent Axis I disorders. Of Axis II disorders, 86.8% evinced a personality disorder most often from the B cluster. A high percentage of the participants received the diagnosis “personality disorder not otherwise specified” (42.1%). There was a high level of comorbidity of mood and anxiety disorders with personality (61%) and substance abuse (47%) disorders. Compared with the general population, the prevalence rates of the separate disorders found among these forensic participants are much higher. The results of this study emphasize the importance of the use of standardized diagnostic instruments and the assessment of a broad range of disorders.

In the present study the relationship between traumatic experiences, dissociation, and borderline personality disorder pathology is examined in a group of 39 male forensic patients and 192 male prisoners. Sexual and emotional abuse are significantly more common among forensic patients than among prisoners. Patients also report a broader range of different kinds of traumas. Prisoners report significantly more dissociative symptoms. Analyses of the relationship of type of trauma on the one hand and dissociation and borderline personality pathology on the other show that sexual abuse is significantly associated with borderline personality pathology but not with dissociation among the patients. In the prison sample these associations are found only for familial but not extrafamilial sexual abuse. When the subjects are grouped on account of presence or absence of a borderline personality disorder, highly significant differences on dissociation are found between both groups. The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events.

No abstract

The effects of an intramural cognitive-behavioral treatment for forensic inpatients with personality disorders in a high-security hospital were examined. Treatment was aimed at modifying maladaptive coping and social skills, at enhancing social awareness, at reducing egoistic and oppositional behaviors, and at reducing psychological complaints. The patients, who all had committed serious crimes (violence, arson, sexual offences), participated voluntarily in the study. A total of 39 patients started the study, but during the course of the study, several patients dropped out because of several reasons. Patients as a group showed significant improvements over time on psychopathological symptoms, personality traits, and coping. A significant decrease of oppositional behaviors was reported by the staff. Though the patients improved well at the group level, only a minority of patients showed reliable change over time at the individual level. The meaning of the results in relation to treatment are discussed.